Page 20 - VOL 26 N. 72 - 2015

June 4, 2015 - Auditoire A. Tissot
FREE COMMUNICATIONS 1
RANDOMIZED CLINICAL TRIAL COMPARING BCRL AND QOL BETWEEN BREAST CANCER PATIENTS TREATED WITH SHORT COURSE IMAGE GUIDED RT AND CONVENTIONAL POST SURGERY RT
ADRIAENSSENS N. 3, LAMOTE J. 1, V AN P ARIJS H. 2, MIEDEMA G. 2, VOORDECKERS M. 2, ERSMESSEN H. 2, DE RIDDER M. 2, STORME G. 2, LIEVENS P. 3, PAS R. 3, MEERHOUT C. 3, DE GRÈVE J. 4, FONTAINE C. 4, VINH-HUNG V. 2
1 Universitair Ziekenhuis Brussel, Breast Cancer Center, Brussels (BE); 2 Universitair Ziekenhuis Brussel, Department of Radiation Oncology, Brussels (BE); 3 Vrije Universiteit Brussel, Physical Therapy Department, Brussels (BE); 4 Universitair Ziekenhuis Brussel, Breast Cancer Center, Brussels (BE)
Introduction: Breast cancer related lymphedema (BCRL) is a well-known complication of breast cancer surgery and radiotherapy (RT) that influences health-related quality of life (HRQOL). The consequences of choosing one RT technology over another for the onset of BCRL are not clearly defined. In the present study, early breast cancer patients are randomized to compare the incidence of BCRL of the arm and the influence on HRQOL between conventional RT and short-course, image-guided RT (IGRT) treatments.
Materials and Methods: Early breast cancer patients were randomized between post surgery IGRT over 3 weeks and conventional RT over 5 to 7 weeks, as part of the TomoBreast trial (ClinicalTrials.gov registration NCT00459628). BCRL and HRQOL were assessed prior to, between 1 and 3 months and every year up to 3 years following RT. BCRL was measured by tape measure in a standardized protocol. Outcome measures were absolute volume of the operated-radiated side (ORS), relative interlimb difference (RID) and subjective arm symptoms. HRQOL was measured using the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 & BR23 questionnaires. Statistical analyses will be discussed during the presentation.
Results: Results of 120 evaluable patients found that < 55% reported subjective arm symptoms at 3 years follow-up, compared
to > 80% at baseline measure. However, there was no significant difference in BCRL incidence between the treatment groups. Absolute volume of the ORS changed significantly (p = .011) over time, with a peak volume at 1 year follow-up. RID increased significantly (p = .004) over time. There was no significant difference in absolute volume of ORS and RID between the treatment groups. No significant difference was found in HRQOL between the treatment groups, except for the dimension ‘global health status’ (p = .022). The conventional therapy group scored significantly better than the IGRT group. Prior to treatment, there was no correlation between RID and the different dimensions of the EORTC QLQ-C30 & BR23. At each post RT measurement, ‘arm symptoms’ were positively correlated with RID (respectively p = .001, .004, .003, .000). At 1 year post RT, patients with a higher RID suffered from more financial difficulties (p = .042), more systemic side effects (p = .038) and a lower body image (p = .008). The financial difficulties were also related with RID at 2 years post RT (p = .005). A high RID at 3 years follow-up was correlated with lower physical functioning (p = .013).
Conclusions: Up to 3 years following RT, short-course IGRT neither caused increased incidence of BCRL, nor decreased HRQOL compared to conventional RT. Although confirmation requires longer follow-up, these results support the use of a short-course RT schedule.
LIPOFILLING OF THE AXILLA TO REDUCE SECONDARY LYMPHEDEMA AFTER AXILLARY LYMPH NODE DISSECTION
VANDERMEEREN L. 1, BELGRADO J.-P. 2, VANKERCKHOVE S. 1, VALSAMIS J.-B. 2, MORAINE J.-J. 2, HERTENS D. 1, CARLY B. 1, LIEBENS F. 1
1 C.H.U. St-Pierre, Bruxelles (BE); 2 Université Libre de Bruxelles (BE)
Introduction: Complete axillary lymph node dissection (cALND) remains a high risk factor to trigger delayed secondary lymphedema. Specialists still investigate the precise reasons why only a limited number of patients develop a breast cancer related lymphedema (BCRL) after cALND. Clearly, ALND is a mandatory but not always a sufficient condition to trigger a lymphedema.
The BCRL physiopathology is complex and multifactorial; venous and microcirculatory impairment also needs to be considered.
During surgery, adipose tissue surrounding the axillary vein is partially or completely removed and the axillary sheath can also be damaged. As previously pointed out by our team, this anatomical disruption could affect the local hemodynamic condition, with as a consequence an increased microvascular filtration at the distal part of the affected limb. Thanks to a set of clinical signs and an original imaging technique, developed in our clinic, we are able to identify those patients with axillary hemodynamic impairment associated with secondary lymphedema. We propose an original and simple surgical approach that could partially restore this hemodynamic impairment.
Material and Methods: Breast cancer patients with longer existing secondary lymphedema and with positive clinical signs for hemodynamic changes in the affected limb, were surgically treated with lipofilling of the axilla. All patients were enrolled in the study protocol (EudraCT n° 2015- 001565-37) with alternating rest, intensive and regular, but standardized, physiotherapy. Water displacement and perimetry techniques were used to measure edematous and normal limb, before the operation and after completion of the study protocol of 44 days. Subjective symptoms as numbness, heavy arm, pain, tension of the skin, were also evaluated. Approval of the patient’s oncologists and ethical committee was obtained for every patient.
Results: 34 patients underwent the surgical intervention. Edema volume reduced significantly in the majority of patients. This reduction was already observed directly after surgery and before starting physiotherapy. Subjective symptoms like heavy arm, numbness, and functional impairment of the upper limb in daily activities started to decrease directly after the operation and continued to decrease after the end of the study protocol. Most of the patients decided not to wear the compression garments anymore, because there was no more change in volume of the arm with our without their use, after the operation. After one year of follow up, we do not record any complications. Details of our findings will be presented at time of presentation.
Conclusion: Lipofilling of the axilla seems to be a simple, fast, cost-effective and efficient surgical approach, and could be introduced as a part of the treatment of secondary upper limb lymphedema after cALND in patients with axillary hemodynamic impairment.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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